In 2007, 500 healthcare refusals were reported to health insurance. The government has decided to tighten the screws and legislate testing with health professionals.
Imagine that in a waiting room, a person could, on the strength of what he reports, convict a doctor for “refusal of illegitimate care” … “If each patient you have in front of you, you suspect him of being a tester, it will break confidence, indignant Dr Fabien Quédeville, general practitioner in Essonne and president of the union of young general practitioners (SNJMG).
Doctors’ offices are there to meet needs, not to play cat and mouse between testers and healthcare professionals. GPs have enough work to avoid wasting their time with bogus patients. The deputies decided otherwise. They voted for a government amendment that allows for random testing of liberal healthcare professionals. If the senators approve this project, the results of these tests will constitute admissible evidence by the ordinal courts or by the directors of the health insurance funds.
Indignation of doctors
This decision sets fire to the powder. The unions are reacting strongly. “It is a relentlessness against the liberal exercise”, denounces one of them. “It is not because there are some black sheep in the profession that we must discredit everyone” , regrets Dr Alain Prochasson, general practitioner in Metz, and member of the UNOF union.
Besides outrage, testing poses a lot of questions. Certainly, surveys have already been carried out among doctors. But so far, they have been done over the phone, and without any consequences. This was the case in Val-de-Marne in 2006. “Our objective was not to sanction,” recalls Bruno Negroni, deputy director of the CMU Fund. The names of the doctors and dentists who refused to make an appointment with CMU patients were not recorded by the company we had hired. The idea was to have a quantified appreciation of the phenomenon and to denounce it ”. According to the survey, 41% of specialists, 39% of dentists and 4.8% of general practitioners refused appointments.
The same year, Médecins du monde carried out a test with 725 general practitioners in ten cities in France. “37% of doctors refused to make an appointment with AME beneficiaries, and 10% refused CMU beneficiaries,” says Dr Pierre Micheletti, president of the humanitarian association.
In short, the refusal of care exists. Following these inquiries, a summit meeting was organized by the public authorities. The Order, health insurance, unions, the High Authority for Combating Discrimination and for Equality (HALDE) were around the table. Measures have been taken: better communicate on the rights and duties of doctors and patients, simplify administrative procedures, in particular for State medical aid (AME), identify professionals who have a much lower number of CMU patients or AME compared to their colleagues. “Unfortunately, these decisions were not followed up,” says Dr Micheletti. In 2007, 500 healthcare refusals were reported by patients to the funds. Suddenly, the Minister of Health decided to move up a gear by legalizing testing, and giving it the value of proof.
Methodological problem
But, how to define a “refusal of care”? For example, for reasons of efficiency, practitioners set prerequisites before receiving patients. “I systematically refuse to welcome a drug addict before they have previously contacted the network with which I work, in order to clarify the initial request and the care plan. Afterwards, the same day or the following, people are welcome without any reluctance, explains Dr Philippe Cornet, general practitioner in the 11th arrondissement of Paris. Most drug addicted patients benefit from CMU or even AME, they could argue for refusal for this reason, when this is not the case. Recently to a person who asked me if “I accepted CMU”, testifies the general practitioner, I answered him that “I did not take care of social covers but of people”. Could this doctor be sanctioned?
Another question is the method used to identify breaches of ethics. “Who will organize these tests? Any natural person? Patient associations? CPAM? »Asks Dr Patrick Bouet, general practitioner and honorary president of the Council of the Order of Seine-Saint-Denis (93). Before this process is employed, the methodology will need to be developed. This work must be carried out jointly by the State, health insurance, health professionals and the orders concerned ”. For the moment, lawmakers have not given any details. They added other measures to fight against the practice of refusal of care, such as the census by the funds of professionals receiving the lowest proportion of CMU beneficiaries among their patients.
Establishment of a conciliation commission
The bill redefines the complaint circuit for refusal of care. Patients will now be able to lodge a complaint either with the departmental councils of the Order, or with the primary health insurance funds. Following the registration of the complaint, a conciliation commission is set up within one month.
In the event of failure, the Order must rule on the sanctions against professionals. In the event of failure by the departmental council, the director of the local health insurance body may take sanctions. “We wanted to encourage professional orders to be more severe”, specifies the deputy Jean-Marie Rolland, rapporteur of the bill.
“It’s too complicated a system,” says Dr Philippe Foucras, general practitioner in Nièvre, president of the Collective of general practitioners for access to care, CoMeGAS, created in 2003. People in precarious situations, who are refused care, have other priorities than filing a complaint with the Order or the funds. “In addition, according to Dr Foucras, health insurance will not be more effective than the Order:” Medicare has a double talk. Since 2008, a circular asks doctors to report to the funds the “exorbitant requirements” of beneficiaries of the complementary CMU. The CoMeGAS lodged a complaint for discrimination with the High Authority for Combating Discrimination and for Equality (HALDE). The file was not followed up.
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